Wound care practices following in-office cutaneous surgery among family physicians in Canada.

OBJECTIVE: Family physicians (FPs) in Canada routinely perform in-office cutaneous surgery. There is strong evidence to support a moist wound healing environment, resulting in faster healing times and improved cosmesis. However, the wound care practices of FPs have not been previously studied. We aimed to examine the postoperative wound care practices of FPs after in-office cutaneous surgery. METHOD: An online survey was distributed to Canadian FPs to determine post-surgical wound care practices. The survey examined moist versus dry wound healing and the reasons for these recommendations were explored. Additional wound care practices were also studied. Appropriate statistical analyses were undertaken. RESULTS: A total of 573 (91.5%) FPs completed the survey. Just under half (49.2%) of FPs recommended moist wound healing to their patients, while the remaining respondents (50.8%) recommended dry wound healing. The most endorsed reason for both moist and dry wound care recommendations was prior training (63.1% and 65.3%, respectively). Most physicians (57.2%) recommended the use of a cream or ointment postoperatively. While there appeared to be consensus on recommending sun avoidance after cutaneous surgery (77.7%), additional wound care practices varied, including: the use of dressings; cleansing practices; smoking cessation; reduction in physical activity; photoprotection; water exposure; and scar treatment/cosmetic use. CONCLUSION: Almost half of FPs in Canada responding to the survey did not recommend moist wound healing despite strong evidence to support this practice. We also noted a diverse range of postoperative wound care practices after in-office cutaneous surgery. Therefore, these results highlight a critical need for consistent wound care recommendations following cutaneous surgery for FPs in Canada.

MgO@polydopamine Nanoparticle-Loaded Photothermal Microneedle Patches Combined with Chitosan Gel Dressings for the Treatment of Infectious Wounds.

As for wound drug delivery, microneedles (MNs) have attracted wide attention. However, while effective at increasing the depth of drug delivery, traditional MNs often have limited drug loads and have difficulty penetrating scabs on wounds. Herein, we develop a drug delivery system combining MgO@polydopamine (MgO@PDA) nanoparticle-loaded photothermal MN patches and chitosan (CS) gel to inhibit the formation of scabs and deliver sufficient drugs into deep tissue. When inserted into the wound, the MN system can keep the wound bed moist and weakly acidic to inhibit the formation of scabs and accelerate wound closure. The released MgO@PDA nanoparticles from both the tips and the backing layer, which immensely increase the drug load, continuously release Mg2+ in the moist, weakly acidic wound bed, promoting tissue migration and the formation of microvessels. MgO@PDA nanoparticles show excellent antibacterial activity under near-infrared irradiation synergized with the CS gel, and the PDA coating can also overcome the adverse effects of oxidative stress. Through in vitro and in vivo experiments, the MN system showed remarkable antibacterial, antioxidant, anti-inflammatory, and pro-angiogenic effects, indicating its potential in the treatment of infectious wounds.

Plus moist HS-W®: a new nasal packing material for the middle meatus in endoscopic sinus surgery.

PURPOSE: Removal of the current calcium alginate packing materials to the middle meatus in endoscopic sinus surgery (ESS) is usually accompanied by discomfort or pain owing to the hard and brittle nature of these materials. Plus moist HS-W® is a new calcium alginate packing material released in 2022 developed to overcome this issue by changing the uronic acid component. We aimed to compare the discomfort/pain during the removal of Plus moist HS-W® with Kaltostat®, as well as their suitability as packing materials in ESS. METHODS: Kaltostat® and Plus moist HS-W® were used as packing materials in 22 and 21 patients who underwent ESS in 2021 and 2022, respectively. Patients were asked to rate the pain during the packing removal 10 days after ESS using the Numerical Rating Scale (NRS). The ratio of residual packing materials, number of suctions (insertions/extractions of the suction cannula), and time required to remove packing materials were measured. Postoperative complications such as hemorrhage, local infection, lateralization of the middle turbinate, and synechia of the middle meatus were also evaluated. RESULTS: The Plus moist HS-W® group exhibited significantly lower NRS pain scores, a lower ratio of residual packing materials, a reduced number of suctions, and a shorter time required to remove the packing. No obvious postoperative complications occurred in both groups except for one suspicious case of a slight infection in the Kaltostat® group. CONCLUSION: Compared with Kaltostat®, Plus moist HS-W®, characterized by better gelatinization than Kaltostat®, benefits patients by minimizing discomfort/pain during removal. LEVEL OF EVIDENCE: Level 3.

Comparativa entre cura en ambiente húmedo y terapia de presión negativa en lesiones por presión. Revisión bibliográfica / Comparative between moist wound healing and negative pressure wound therapy in pressure injuries. Literature review

ObjetivoEl objetivo general es establecer qué tipo de cura, la cura en ambiente húmedo o la terapia de presión negativa, es más eficiente para el tratamiento de las lesiones por presión. También, identificar los índices de coste-efectividad, contrastar los resultados obtenidos al aplicar los 2 tipos de curas en las diferentes categorías de lesiones por presión, determinar los conocimientos y percepción de enfermería en el ámbito de las lesiones por presión, y comparar las sensaciones experimentadas por los pacientes al recibir las curas. Metodología: Se realizó un estudio de coste a partir de una revisión bibliográfica en las siguientes bases de datos: SciELO, Google Académico, CUIDEN, IBECS, Elsevier, PubMed, MEDLINE, Dialnet, Scopus y CINAHL, durante los meses de septiembre a diciembre de 2020. Resultados: Se obtuvieron un total de 31 artículos que hacen referencia a la cura en ambiente húmedo y/o a la terapia de presión negativa aplicadas en lesiones por presión de diferentes categorías. Dichos documentos están comprendidos entre 2010 y 2020, ambos incluidos, muestran el texto completo y están publicados en español o inglés. El 82% de los documentos analizan el índice coste-efectividad, teniendo en cuenta el gasto final de tratamiento y los resultados de cada tipo de cura, entre otras variables. Conclusiones: El tratamiento de elección para las lesiones por presión categorías I y II es la cura en ambiente húmedo, mientras que en las lesiones por presión categorías III y IV, la evidencia científica actual muestra mejores resultados con terapia de presión negativa (AU)

Objectives: The general objective is to establish which type of cure, the moist wound healing (MWH) or the negative pressure wound therapy (NPWT), is more efficient for the treatment of pressure injuries (PI). Also, to identify the cost-effectiveness indices, to compare the results obtained by applying the two types of treatment in the different categories of PI, to determine the knowledge and perception of nursing in the field of PI and to compare the sensations experienced by patients when receiving treatment. Methodology: A cost study was made based on a literature review in the following databases: SciELO, Google Scholar, CUIDEN, IBECS, Elsevier, PubMed, MEDLINE, Dialnet, Scopus and CINAHL, during the months of September to December 2020. Results: A total of 31 articles were obtained that refer to MWH and/or NPWT applied in PI of different categories. These documents are from 2010 to 2020 both inclusive, show full text and are published in English or Spanish. 82% of the documents analyse the cost-effectiveness index, including the final cost of treatment and the results of each type of cure, among other variables. Conclusions: The treatment of choice for PI categories I and II is MWH, while in PI categories III and IV the current scientific evidence shows better results with NPWT (AU)

3D-Printed Gelatin-Alginate Hydrogel Dressings for Burn Wound Healing: A Comprehensive Study.

Burn wound treatment is still a clinical challenge due to the severity of tissue damage and dehydration. Among various wound dressings, hydrogel materials have gained significant attention for burn wound treatment in clinical practice due to their soothing and moisturizing activity. In this study, 3D-printed dressings were fabricated using clinically relevant hydrogels for deep partial-thickness burn (PTB) wounds. Different ratios of gelatin and alginate mixture were 3D-printed and examined in terms of rheological behavior, shear thinning behavior, mechanical properties, degradation rate, and hydration activity to tune the hydrogel composition for best functionality. The cell-laden dressings were bioprinted to evaluate the effect of the gelatin: alginate ratio on the proliferation and growth of human dermal fibroblasts. The present findings confirm that the higher alginate content is associated with higher viscosity and Young's modulus, while higher gelatin content is associated with faster degradation and higher cell viability. Together, the 3D-printed dressing with 75% gelatin and 25% alginate showed the best tradeoff between mechanical properties, hydration activity, and in vitro biological response. Findings from in vivo test using the most effective dressing showed the positive effect of 3D-printed porous pattern on wound healing, including faster wound closure, regenerated hair follicles, and non-traumatic dressing removal compared to the non-printed hydrogel with the same composition and the standard of care. Results from this research showed that 3D-printed dressings with an adequate gelatin: alginate ratio enhanced wound healing activity for up to 7 days of moisture retention on deep PTB wounds.

Chitosan and polyhexamethylene guanidine dual-functionalized cotton gauze as a versatile bandage for the management of chronic wounds.

Development of versatile medical dressing with good immediate and long-lasting antibacterial, hygroscopic and moisturizing abilities is of great significance for management of chronic wounds. Cotton gauze (CG) can protect wounds and promote scabbing, but can cause wound dehydration and loss of biologically active substances, thereby greatly delays wound healing. Herein, a bi-functional CG dressing (CPCG) was developed by chemically grafting polyhexamethylene guanidine (PHMG) and physically adsorbing chitosan (CS) onto the CG surface. Due to the powerful microbicidal activity of PHMG, CPCG exhibited excellent immediate and long-lasting antibacterial activity against gram-positive and gram-negative bacteria. Moreover, the abundant hydroxyl and amino groups in CS endowed CPCG with good biocompatibility, moisture absorption, moisturizing and cell scratch healing performances. Importantly, CPCG can be easily fabricated into a bandage to conveniently manage infected full-skin wounds. Together, this study suggests that CPCG is a versatile wound dressing, having enormous application potential for management chronic wounds.

Application Of Cling Film Over Burn Wounds (Occlusive Wound Dressing): Our Experience.

BACKGROUND: This study shares our experience and review the outcome of the use of cling film with silver sulfadiazine cream in terms of healing time, and patient's satisfaction score. METHODS: It was a descriptive case series conducted at Jinnah Burn and Reconstructive Surgery Center, Lahore, from March 2018 to February 2019. In this study, a thick layer of silver sulfadiazine was applied and then wrapped with cling film on 35 patients sustained mix thickness burns on the trunk and limbs. Dressing was done daily after wound wash with normal saline. Consultant Plastic surgeon assessed the wound healing by observation and serial photographs. Duration of wound healing and complications were noted. RESULTS: Complete wound healing was achieved in 25 (71.4%) patients with mean healing time of 13.3 days (range 11-15 days). The wound infection was seen in 5 (14.2%) patients, that were diagnosed by change in colour of wound edges and patients with signs of sepsis (ABA scoring). Sepsis was treated in 5 patients with debridement and culture specific antibiotics. split skin graft done in 8 (22.8%) cases. CONCLUSIONS: Moist wound dressing with Silver Sulfadiazine and cling film is cost effective, easy to apply with good visibility of the wound and has good patient satisfaction, but is labour intensive.

Moist Wound Healing with Commonly Available Dressings.

Significance: A moist wound environment has several benefits that result in faster and better quality of healing. It facilitates autolytic debridement, reduces pain, reduces scarring, activates collagen synthesis, facilitates and promotes keratinocyte migration over the wound surface, and supports the presence and function of nutrients, growth factors, and other soluble mediators in the wound microenvironment. Recent Advances: Wound dressings can be utilized to create, maintain, and control a moist environment for healing. Moist wound dressings can be divided into films, foams, hydrocolloids, hydrogels, and alginates. We are also including negative pressure wound therapy systems in the moist dressings. Critical Issues: An optimal wound dressing should provide a moist environment and have an optimal water vapor transmission rate (WVTR) and absorptive capacity. It should also protect the wound against trauma and contamination and be easy to apply, painless to remove, and esthetically acceptable or even pleasing. Future Directions: Interventions, particularly dressing changes, by medical caregivers are labor intensive and expensive and there should be a continuous effort to reduce their number per week. Smart dressings with integrated microsensors and delivery capabilities that would allow wireless real-time monitoring and treatment of the wound would be very advantageous. This way the state of the wound as well as the wear time of the dressing could be assessed without dressing removal or visit to the wound care center. In addition, an ability to adjust the WVTRs to the exudate level of the wound (or having a large absorptive capacity without changing the WVTR) would be useful. This feature would guarantee an optimal level of hydration of the wound surface throughout the treatment.

New tools in wound care to support evidence-based best practice.

Throughout history, various wound healing and management concepts have been recorded, with some approaches such as honey, silver and larvae still in use and others such as blood-letting completely dismissed. In more recent times, dressing products have begun evolving, moving on from basic first-aid supplies to products that support positive healing by addressing the needs of the wound bed and considering underlying factors that impact healing. With an ageing population, the incidence of chronic wounds is predicted to rise, and chronic wounds can negatively impact the lives of patients physically, emotionally and financially. Clinicians continue to explore and review new approaches surrounding the management of wounds, as it is imperative that clinicians use technological advances in wound management alongside established gold standard evidence-based practice to achieve positive outcomes for patients experiencing delayed or challenging wound healing.

Understanding and addressing dryness during wound healing.

Timely wound healing supports positive outcomes for both the patient and the clinician. The cause of a non-healing wound needs both identifying and addressing. A dry wound bed will result in a lengthy healing process, impacting both the patient and the clinician, physically and financially. It is imperative to correctly identify the cause of a non-healing wound and address the causative factors using evidence-based best practice. A non-healing wound may be attributed to various factors, such as inappropriate dressing, lack of hydration, medication or underlying medical disease. Identification of the cause will support the most appropriate management choice. In order to explain the issues of a dry wound, it is imperative that the clinician first has an understanding of the concept of moist wound healing.

Use of a gelling fibre dressing in complex surgical or chronic wounds: a case series.

OBJECTIVE: To evaluate the safety and performance of a gelling fibre dressing, with respect to wound exudate management, maceration and periwound skin conditions. METHOD: Complex (non-healing) surgical or chronic wounds healing by secondary intention were treated with a gelling fibre dressing (Biosorb, Acelity) as part of a prospective, two-centre case series product evaluation study. Dressing performance was evaluated at each change, and weekly for up to four weeks or until the wound healed, if this was in less than four weeks. The main outcome measure was dressing performance, wound bed and periwound skin condition. RESULTS: A total of 15 patients, aged 26-87 years, were enrolled; 10 patients (66.7%) presented with chronic wounds including venous leg ulcers (VLUs), arterial leg ulcer, one mixed leg ulcer, pressure ulcer (PU), and diabetic foot ulcers (DFUs). The remaining wounds (33.3%) were postsurgical complex wounds healing by secondary intention, located in the upper leg, foot, abdomen, and sacrum. Mean wound area was 22.6±36.6cm2 (range: 1.3-144.0cm2). Treated wounds showed complete granulation in eight (53.0%) wounds, 75% granulation coverage in two (13.3%) wounds, 50% coverage in three (20.3%), and 25% coverage in two (13.3%) wounds. Patients evaluated the dressing effectiveness as 'excellent' or 'very good' in 45% of cases, 'moderate' in 45%, and 'poor' in 10% of cases. Results of Visual Analogue Scale (VAS) showed 70% of patients rated their pain as 'low' and 30% as 'moderate' at dressing removal. Clinicians' evaluation of dressing ability to absorb and retain wound exudate was rated 'excellent' or 'very good' in 80% of cases, and moderate in 20% and poor in 10% of cases. Overall, clinicians' impression of the dressing performance was reported as 'excellent' or 'very good' in 80% of cases and 'moderate' in 20% of cases. No patient had to be removed from the study due to adverse events directly related to the dressing or its performance. CONCLUSION: These clinical findings suggest the new gelling fibre dressing to be safe and effective in wound treatment of complex (non-healing) surgical or chronic wounds, to manage exudate effectively, and to optimise the conditions of wounds healing by secondary intention.

Efficacious use of a Calgigraf Ag foam dressing in complete healing of a difficult-to-heal, long-standing ulcer of osteoradionecrosis.

A number of dressings containing silver have been recently introduced into the wound care market as increased resistance to antibiotics has become a problem in treating infected wounds. A 54-year-old male, with adenoid cystic carcinoma treated by segmental resection and reconstruction of mandible using reconstruction plate with concomitant radiotherapy, resulted in a deep extraoral nonhealing necrotic, exuding, malodorous, and painful wound. Erythema, eczema, and trophic changes were surrounding the skin. Previous treatment was removal of exposed reconstruction plate and primary closure. Culture samples reported methicillin-resistant Staphylococcus aureus positive and sensitivity to linezolid. Repeated failed attempts to approximate the wound, prompted the use of Calgigraf Ag foam as dressing for the wound. Evidence of new tissue growth and subsequent reduction in wound area and exudate were significant. Chronic nonhealing wounds involving progressive tissue loss give rise to the biggest challenge to wound-care researchers. Despite proper care, some wounds fail to heal in normally and become chronic. The use of ionic silver with negative pressure therapy is safe and effective in difficult nonhealing wounds. This case illustrates the potential benefit of ionic silver combined with negative pressure and moist wound healing as management of a patient with long-standing, nonhealing, and osteoradionecrosis wound. Calgigraf Ag Foam a silver alginate dressing is optimal for maintaining moist environment vital to promote wound healing. It needs less frequent dressing changes with additional benefits such management of excessive exudate minimising malodour and maintaining a moist wound environment.

Effect of moist healing therapy on severe pressure ulcers and nursing measures / 现代临床护理

Objective To explore the effect of moist healing therapy on severe pressure ulcers in stage III-IV and summarize the nursing points. Methods Forty-five patients with stage III-IV pressure ulcers (62 cases) were randomly divided into 23 patients of control group (30 cases) and 23 patients of observation group (32 cases). The control group was treated with conventional pressure ulcer care. The observation group was treated with alderate dressing, hydrocolloid dressing and recombinant human epidermal growth factor gel. The wound healing time and wound healing effect were compared between the two groups. Result The total effective rate of the observation group was significantly higher than that of the control group (P<0.01). Conclusion The clinical effect of moist healing therapy combined with wet dressing in the treatment of severe pressure ulcer wound in stage III-IV is superior to that of traditional pressure sore treatment, for it can shorten the healing time and increase the healing rate.

Effect of moist healing therapy on severe pressure ulcers and nursing measures / 现代临床护理

Objective To explore the effect of moist healing therapy on severe pressure ulcers in stage III-IV and summarize the nursing points. Methods Forty-five patients with stage III-IV pressure ulcers (62 cases) were randomly divided into 23 patients of control group (30 cases) and 23 patients of observation group (32 cases). The control group was treated with conventional pressure ulcer care. The observation group was treated with alderate dressing, hydrocolloid dressing and recombinant human epidermal growth factor gel. The wound healing time and wound healing effect were compared between the two groups. Result The total effective rate of the observation group was significantly higher than that of the control group (P<0.01). Conclusion The clinical effect of moist healing therapy combined with wet dressing in the treatment of severe pressure ulcer wound in stage III-IV is superior to that of traditional pressure sore treatment, for it can shorten the healing time and increase the healing rate.

The importance of hydration in wound healing: reinvigorating the clinical perspective.

Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

Current concepts in wound management and wound healing products.

Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

Using a silicone-based dressing as a primary wound contact layer.

The use of silicone-based dressings as a primary contact layer for wound care can prevent epithelial stripping, pain and sensitivity and have been widely available for nearly 20 years. Cuticell Contact from BSN medical is the latest silicone-based dressing to add to the armoury of the wound care clinician. Using documented case studies the author explores the reasoning behind why clinicians should consider re-examining the use of silicone dressings.

Flaminal enzyme alginogel: a novel approach to the control of wound exudate, bioburden and debridement.

A multidisciplinary panel of Woundcare experts of international repute was assembled to review the clinical evidence and advise on the classification of the Flaminal products. This is based on their exact role in wound management and is to be defined on the basis of clinical efficacy, evidence and utility. Experts of international repute from Australia, Belgium, Czech Republic, France, Germany, Italy, Netherlands, and UK participated in this exercise.

Wet-to-Dry Dressings Do Not Provide Moist Wound Healing.

The purpose of this study was to determine if using advanced wound care dressings leads to improved outcomes as compared to wet-to-dry dressings. Based on a review of literature published in the last eight years, with the exception of one landmark article published in 2001, strong support was found that advanced wound care dressings improved outcomes when compared to wet-to-dry dressings. Some of the outcomes compared were healing time, pain, infection rates, and costs; several articles took it a step further stating that the use of wet-to-dry dressings is considered sub-standard practice. The articles provided evidence-based support for the use of moist wound healing.